Fujii Shoko, Fujita Kyohei, Ishikawa Mariko, Shigeta Keigo, Aizawa Yuki, Yoshimura Masataka, Hirota Shin, Ito Kei, Yoshino Yoshikazu, Yamada Kenji, Takahashi Satoru, Sagawa Hirotaka, Kinoshita Yuki, Kobayashi Yusuke, Hirai Sakyo, Sumita Kazutaka
Department of Endovascular Surgery, Institute of Science Tokyo, Tokyo, Japan.
Department of Neurosurgery, Ome Medical Center, Tokyo, Japan.
World Neurosurg. 2025 Feb;194:123496. doi: 10.1016/j.wneu.2024.11.079. Epub 2024 Dec 9.
Endovascular treatment has become the preferred approach for managing unruptured cerebral aneurysms, with simple and balloon-assisted coil embolization as the standard first-line therapy. However, recanalization after coil embolization remains a major clinical concern. This study aimed to evaluate the predictive factors for recanalization using time-of-flight magnetic resonance (TOF-MR) angiography.
This retrospective multicenter study analyzed data from 241 patients with unruptured cerebral aneurysms who underwent coil embolization at 5 stroke centers. Aneurysms were evaluated using TOF-MR angiography within 7 days postprocedure and at follow-up. The study investigated the role of aneurysm characteristics and the Postoperative TOF-MR Angiography (PTMA) classification in predicting recanalization.
Of the 241 aneurysms analyzed, 79 (32.7%) exhibited recanalization, and 15 (6.2%) required retreatment. Aneurysms with a maximum diameter of ≥10 mm were associated with a higher risk of recanalization (odds ratio, 3.27; 95% confidence interval (CI), 1.38-7.75; P < 0.01). The PTMA classification, which indicated incomplete occlusion (small residual neck/residual neck/partial occlusion), also showed a significant association with recanalization (odds ratio, 4.82; 95% confidence interval, 2.17-10.7; P < 0.01). The modified Raymond-Roy classification (Class IIIb) also contributed to the prediction of recanalization (odds ratio, 3.09; 95% confidence interval, 1.50-6.38; P < 0.01).
Aneurysm size, the modified Raymond-Roy classification, and PTMA classification within 7 days of coil embolization were significant predictors of recanalization. This study suggests that TOF-MR angiography may be accurate, and that PTMA classification may serve as an appropriate predictor of aneurysm recanalization. Further prospective studies with larger cohorts are required to validate our findings.
血管内治疗已成为处理未破裂脑动脉瘤的首选方法，单纯弹簧圈栓塞和球囊辅助弹簧圈栓塞是标准的一线治疗方法。然而，弹簧圈栓塞后的再通仍然是一个主要的临床问题。本研究旨在使用时间飞跃磁共振（TOF-MR）血管造影评估再通的预测因素。
这项回顾性多中心研究分析了来自5个卒中中心接受弹簧圈栓塞的241例未破裂脑动脉瘤患者的数据。在术后7天内及随访时使用TOF-MR血管造影对动脉瘤进行评估。该研究调查了动脉瘤特征和术后TOF-MR血管造影（PTMA）分类在预测再通中的作用。
在分析的241个动脉瘤中，79个（32.7%）出现再通，15个（6.2%）需要再次治疗。最大直径≥10mm的动脉瘤再通风险较高（比值比，3.27；95%置信区间（CI），1.38 - 7.75；P < 0.01）。PTMA分类显示为不完全闭塞（小残留颈/残留颈/部分闭塞）也与再通显著相关（比值比，4.82；95%置信区间，2.17 - 10.7；P < 0.01）。改良Raymond-Roy分类（IIIb级）也有助于预测再通（比值比，3.
